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Patient Forms

At Digestive Specialists, your time is as valuable to us as it is to you. When you arrive for your first office visit, a member of our staff will provide you with the required forms to fill out. There may be additional forms if you schedule a procedure. If you happen to misplace any of the provided forms, duplicates are available below.

Please visit our Prep Instructions page for specific instructions for your procedure.

Medical Records Release – Office Visits

Please print, complete, and sign this form if you need your medical records from Digestive Specialists, Inc.

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Medical Records Release – Procedures

Please print, complete, and sign this form if you need your medical records from Digestive Endoscopy Center, LLC.

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Notice of Nondiscrimination

Digestive Endoscopy Center, LLC does not discriminate or exclude on the basis of race, color, national origin, age, disability, or sex. Language services are available upon request.

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gPortal Getting Started Card

Quick Reference Guide for Using gPortal

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Billing Information Form

Understanding medical billing can be complicated. Our FAQs were created to help alleviate the confusion.

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DSI Notice of Privacy Practices

Privacy Notice for office visits.

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DECL Notice of Privacy Practices

Privacy Notice for procedures.

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Patient Rights and Notification Brochure

This document describes your rights as a patient.

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Referring Physician Form

1-Step GI Referral

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